MEDICARE: WE ROCK THE SPECTRUM KID'S GYM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1619816535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WE ROCK THE SPECTRUM KID'S GYM, LLC

Provider Business Mailing Address
First Line	:	5520 CREBS AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-3330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 CREBS AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-3330
Country	:	US
Telephone Number	:	818-585-5687
Fax Number	:

Authorized Official
Title or Position	:	OWNER & PROGRAM DIRECTOR
Name	:	DINA KIMMEL
Credential	:
Telephone Number	:	818-585-5687

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	04/08/2026

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